- BIOETHICS FORUM ESSAY
If you follow breast cancer as a nonclinician, you quickly learn that the San Antonio Breast Cancer Symposium is the meeting to watch: advocacy groups send correspondents, file reports, and hold post-meeting web conferences to discuss the latest research findings and clinical advances. But the big news out of this year’s meeting, which opened December 14, has already hit the headlines: In 2003, the rate of new cases of breast cancer in the United States fell by 7 percent. To put this another way, 14,000 women were not diagnosed with breast cancer in that year. The single-year drop – described in news reports as “startling” and “huge”– was uncovered through an analysis of federal cancer-registry statistics. Almost more startling is the leading theory for the reason for the drop. In 2002, a “safe” drug – hormone replacement therapy – was found to increase the risk of breast cancer. In the months that followed the announcement, millions of post-menopausal women decided to stop taking this drug. Researchers theorize that some of these women would have been diagnosed with hormone-receptive positive cancers in 2003 – had the supply lines to nascent cancer cells not been cut off in 2002.
The news out of San Antonio reminded me that one of the ways patient safety experts drive home the extent of medical error as a health care problem is to compare to breast cancer: in the United States, mistakes kill more patients than breast cancer does. Because medications are the leading cause of medical injury, these experts urge clinicians not to restrict their safety efforts to preventing known types of errors, such as ordering the wrong drug or delivering the wrong dose. To prevent harm, clinicians must also be wary of the very concept of a “safe drug.” They must investigate “typical complications” to determine if these are in fact harms caused by allergies, side effects, or interactions. Once they know or suspect a drug is harmful, they have an obligation to protect patients from that harm. The startling possibility that 14,000 women were not diagnosed with breast cancer in 2003 because they stopped taking their hormone replacement pills in 2002 is a Power Point-ready lesson in the danger of holding any drug harmless.
– Nancy Berlinger